Case Study #5a — Psychosis
Daily Jessica feels thoughts are being put
Background Information
Jessica is an 18 year-old female with recent
abnormal behaviour and perceptual
disturbances. She describes a history of
recurrent depressive feelings since the age
of twelve. Last year her feelings of
depression intensified, resulting in food-
intake restriction and a loss of twenty
pounds. In June of 2008 Jessica was
hospitalized for one week after an overdose
of sleeping pills. After discharge she saw a
therapist weekly and underwent noticeable
improvements in her
mood and functioning.
Jessica was suddenly
re-hospitalized in
February of this year
for four days.
Hospitalization was
necessary following an
episode at school
during which Jessica
became highly
disoriented and
confused, convinced
that her boyfriend had died based upon
signs that were presented to her (e.g. the
school counselor wearing white, the nurses
wearing cross necklaces).
Unusual Thought Content
Jessica commented that things seem
strange and “crazy all the time” since her
most recent hospitalization. She described
frequent déjà vu experiences; for example
she was certain that she had seen the
assessor before the interview “at the
hospital, in the shower but it was another
girl who kept getting thicker and thicker.”
into her head “like a high force is interfering”
and she can read other people’s minds.
She also feels music is communicating
with her and sending special messages
“every day of my life.
Jessica believes she can predict the future
as evidenced by thinking about or dreaming
things, which then occur. On a daily basis
she has the feeling that she is “dead, in
paradise or heaven but my parents still
exist.” Jessica also described seeing
significant signs in her everyday
experiences, which she is unable
to interpret [this quotation is an
example of very disturbed thought
content indicative of psychosis]:
“I want to know the benefits and
effects of what’s happening to
me. I see angels, reflections and
license plates that say June or
July. Every day is happy birthday
to me because things are so
beautiful and life is wonderful. I
am bleeding by love and miss my lover. It’s
like breathing, like this (Jessica stands up
and reaches toward the light fixture in the
interview room), like an umbilical cord. Take
it one step at a time. China Town. Little
Tokyo. I learned a lot from their cultures. I
love all cultures.”
Suspiciousness
Since hospital discharge Jessica has felt
“watched”. She constantly feels
hypervigilant, “I pay attention to every detail
in the room. I feel I have to control it all.”
Jessica has recently felt mistrustful and
feels others are thinking of her in a negative Jessica experiences this odor several times
way. Jessica feels increasingly uneasy and a week for periods as long as 30 minutes.
suspicious that people are against her or
may cause her harm. She will not walk Communication Disturbances
through her school campus alone even in Jessica has substantially impaired
the day time and she is watchful for any communication. During the course of the
“suspicious” behaviors from people around interview, Jessica often rambled and lost
her such as wearing a large coat in the track of the topic. Her speech patterns were
summer. Because of her uneasiness highly tangential, incoherent and often
Jessica is becoming more seclusive and failing to reach the point.
commented “I want to go out but can’t
because I am the center of attention”. Comments
Jessica presents with many defining
Grandiosity
characteristics of psychosis with thought,
Jessica believes that she has special gifts perception and behavior being markedly
and talents and thus displays severe disordered:
grandiosity: “I can dance, sing and act
 Jessica has severely disturbed thought
exceptionally well. At the hospital I
content at a psychotic level of intensity
pretended to be Paris Hilton, who I think is
for prolonged time periods on a daily
wonderful. I also pretended to be Cinderella
basis. Jessica displays disorganized
which, who knows, I could be.”
speech/thinking and grossly
Perceptual Disturbances disorganized behavior. She has been
hospitalized twice for being a danger to
Jessica has auditory, visual and olfactory
herself.
hallucinations. During her hospital stay,
Jessica thought she heard “horse’s
hooves,” which she interpreted as her
 Jessica has severe and psychotic
perceptual disturbances involving
boyfriend coming to rescue her, adding, “He
vision, hearing and smell. These
is a Sagittarius so I thought he was half-
hallucinations are recurrent and are
horse half-man.” Several times a day she
perceived as real.
also frequently hears him calling her name
and she will respond by looking for him.
Jessica believes that colors appear brighter
 Jessica presents with suspiciousness
at a severe level of intensity and
since her hospitalization, and describes
frequency. She is constantly
recently seeing her boyfriend’s fully formed
hypervigilent and her behavior is
image everywhere. In the past two months
influenced by her beliefs. Jessica is
Jessica has become aware of an extremely
avoidant of certain situations (e.g.
foul odor, which goes unnoticed by others.
walking alone through school campus)
Jessica expressed concern that it was
and she is becoming more seclusive.
poison. In an attempt to make the odour
disappear Jessica puts soap in her nostrils.
  Grandiosity is at a psychotic level.
Jessica has an exaggerated self-opinion
and special identity.

 Prior to the emergence of psychotic

symptoms Jessica had a prolonged
prodromal period marked by depression.

Jessica Should be Referred to the Early

Psychosis Treatment Service (EPTS)

Call 403-944-4836

OR

Fax 403-944-4008

Copyright © 2010 Jean Addington and Lisa McGregor